Abstract
Introduction
Globally, attitude toward sexual and gender minorities have been stigmatized in many cultures for decades. Erstwhile same-sex behaviors were illegal in India, the Supreme Court of India granted constitutional recognition to trans-genders as the third gender, and any discrimination toward them was considered a violation of their constitutional rights in April 2014. Despite being labeled “unconstitutional” in the judgment of the Supreme Court of India in 2018, its effects have not yet been done away with. Several studies indicate that LGBT people have unique healthcare needs, both physically and mentally. Because of stigmatization among medical fraternities, they avoid routine healthcare facilities. Over the years, there has been significant progress in attitudes toward homosexuality among health professionals, but homophobia still persists at a worrying level. Although significant progress in health professional’s attitudes toward homosexuality over the years, still continued to be a worrying prevalence of homophobia among them. Health professionals are expected to uphold ethical standards and provide nonjudgmental care to all the patients including sexual and gender minorities.1-4
The health professional’s attitude toward homosexuality is crucial in determining the level of care provided to the LGBT community. It has been documented to be influenced by various factors, including personal beliefs, cultural norms, and religious values. Moreover, lack of knowledge and training on homosexuality issues can also contribute to negative attitudes and discrimination toward patients who identified them as homosexuals. 5
Numerous studies have been published on the knowledge and attitude of health professionals toward homosexuality. A study conducted in Canada found that the health professionals exhibited negative attitudes toward homosexuality. 6 Another study conducted in Turkey found that the health professionals held negative attitudes toward homosexuality. 7 Indian studies found the inadequate knowledge and a negative attitude toward homosexuality in medical students.8,9
In their opinion, health professionals lack the skills to deal with sexual orientation issues within patients, and this problem may be further compounded by clinician homophobia, which adversely impacts the doctor–patient relationship and treatment outcome.10,11 The Kerala High Court directed the National Medical Commission, and Undergraduate Medical Education Board to consider and take a decision on removing unscientific data and derogatory terms used against sexual minorities in September 2021. 4 It is crucial that healthcare professionals are educated on how to assess and treat these patients without prejudice or discrimination. In order to reduce healthcare disparities, medical teachers are vital in preparing medical students to provide better healthcare to these marginalized communities. 8
The available research on the attitude of health professionals and their greater acceptance of homosexuality is limited. Therefore, it is imperative to investigate the attitude of health professionals toward homosexuality to identify gaps in knowledge and provide necessary interventions to promote positive attitudes toward homosexuality in an ever-changing social environment.
Subject and Methods
Methodology
A cross-sectional study was carried out among the health professionals at Dr. M.K Shah Medical College and Research Center from May 2022 to September 2022. All the participants were approached via prior communication to ensure maximum attendance. Permission was taken from the Dean and the concerned authority to take an interactive session on questions and myths related to Homosexuality. Participants who were present on the day of the session and those who gave consent were included in the study. Before the session, students were requested to fill out proforma containing: (a) demographic details and (b) the attitudes toward Gay/Lesbians Questionnaire. After 15 minutes, all the papers were collected from the participants, and the interactive session on homosexuality was taken by the experienced consultant psychiatrist.
Materials
Semistructured Proforma
The survey included demographic information such as age, gender, home address, living status, sex at birth, residing in a household with religious practice, having homosexual friends, and sexual orientation.
Attitude Toward Gay/Lesbian Questionnaire
It contains 21 items self-report questionnaires, each question is scored on a five-point Likert scale ((a) “strongly agree,” (b) “agree to an extent,” (c) “neutral,” (d) “disagree,” (e) “strongly disagree”). Among them 1st, 2nd, 6th, 8th, 13th, 14th, 18th, 19th, 20th, and 21st questions are scored reverse in five-point Likert scale. The scale showed excellent internal consistency (alpha = 0.93), and good test-retest reliability (
Statistical Analysis
In order to analyze the collected data, Statistical Package for Social Science Version 20.0 was used. The responses of participants have been expressed in terms of frequency and percentage. The distribution of the dependent variable did not follow a normal distribution as assessed by the Kolmogorov–Smirnov test. Mann–Whitney
Observations
Five hundred and thirty-two health professionals completed their proforma, and the remaining incomplete forms were not included in the analysis. There were 45.5% males and 54.5% females among the participants. The mean age of participants was 27.71 years and the standard deviation among age distribution was 3.946. There were 81.2% heterosexuals, 7.3% homosexuals, 2.8% bisexuals, and 8.6% participants who did not wish to respond. Overall, 16.4% of participants reported having homosexual friends, and 83.6% having heterosexual friends. A total of 74.8% of participants belong to families where religious practices were routinely performed, and 25.2% belong to families where no religious practice was routinely performed. Demographic details are presented in Table 1.
Distribution of Demographic Details.
Distribution of Participant’s Sexual Orientation and ATHQ Score.
Overall, the mean score of attitude toward homosexuality questionnaire was 73.04 + 23.39.
As measured by the Mann–Whitney
By using the Mann–Whitney
As measured by the Mann–Whitney
The Mann–Whitney
When comparing people who have homosexual friends with their attitudes toward homosexuality, Mann–Whitney
A Mann–Whitney
Kruskal–Wallis H test shows that there is a statistically significant difference between the three groups with attitude toward homosexuality, H (3) = 157.36,
Discussion
The present study examined the attitude of health professionals toward homosexuality. Although participants reported fairly positive attitudes toward homosexuality, there were differences in attitudes toward homosexuality among the participants according to their demographic distribution.
The current study found that males had lesser degree of positive attitude compared to higher degree of positive attitude of females. Similarly, a study conducted among the Asian population in 2018 found a lower acceptance of homosexuality among men than among women; such findings indicate that social debates on same-sex marriage have more of an impact on men. 13
According to a study conducted in India, females tend to have more negative attitudes toward gays and lesbians. Girls’ attitudes toward homosexuality may be influenced by more societal and cultural restrictions than boys. 14 A key role of the government is to prevent misinformation against the LGBT community from being spread.
The present study observed that participants who belonged to rural domiciles had a more negative attitudes toward homosexuality compared to participants who belonged to urban population. Rural Indian health professionals had more negative attitudes toward gay and lesbian people in comparison to urban students in a study among adolescents. There is a possibility that it is caused by participant’s belonged to urban area sharing a combined global culture and having a greater degree of freedom than students from rural areas, where a conservative culture affects their thinking and attitudes. 14
The current study observed that participants who belonged to the joint family had a more negative attitude toward homosexuality compared to participants who belonged to the nuclear family. This may be due to the different family dynamics of nuclear and joint families. It is common for parents to have more negative attitudes toward homosexuality than their children, as older generations tend to be less accepting of homosexuals. 15 It will be important to further clarify how family dynamics affect attitudes toward homosexuality through future large-scale studies.
As compared to participants with homosexual friends, participants with heterosexual friends had more negative attitudes toward homosexuality in the present study. It may be due to increased understanding and acceptance of homosexuality in friendship. The importance of close friendship for gay men and lesbians has been gaining attention in recent years.16,17
The current study found that participants with heterosexual orientation had more negative attitudes toward homosexuality compared to participants with other than heterosexual orientation. A possible explanation for this result lies in the spectrum of social interactions. Homosexuals often feel reluctant to reveal their sexual orientation because of the social stigma associated with it. Because heterosexuals are hardly able to interact with nonheterosexuals, many heterosexuals may continue to hold traditional homo-negative attitudes. In order to introduce heterosexual people to unbiased viewpoints of homosexuality, it takes sustained efforts to increase interaction between them and LGB individuals. 13
Limitations
The results of this study cannot be generalized; large-scale studies, with more number of studied parameters, eliminate response biases are needed to provide a definitive conclusion. The degree of religiosity and cultural aspects of attitude toward homosexuality have not been explored as comprehensively in this study.
Conclusion
Health professionals had lesser degree of positive attitude toward homosexuality; they need sensitization and correction of their misconception toward homosexuality. Being male, living in a nuclear family, rural domicile, and participants having heterosexual friends reported negative attitudes toward homosexuality. Although NMC revised undergraduate curriculum related to homosexuality, workshops and interactive sessions will be required to resolve their queries, and to enrich their understanding of homosexuality. The positive attitude of health professionals would improve the healthcare needs of patients with homosexuality.